Belletti Alessandro, Benedetto Umberto, Biondi-Zoccai Giuseppe, Leggieri Carlo, Silvani Paolo, Angelini Gianni D, Zangrillo Alberto, Landoni Giovanni
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
University of Bristol, School of Clinical Sciences, Bristol Heart Institute, Bristol, United Kingdom.
J Crit Care. 2017 Feb;37:91-98. doi: 10.1016/j.jcrc.2016.08.010. Epub 2016 Aug 13.
Inotropes and vasopressors are cornerstone of therapy in septic shock, but search for the best agent is ongoing. We aimed to determine which vasoactive drug is associated with the best survival.
PubMed, BioMedCentral, Embase, and the Cochrane Central Register were searched. Randomized trials performed in septic patients with at least 1 group allocated to an inotrope/vasopressor were included. Network meta-analysis with a frequentist approach was performed.
The 33 included studies randomized 3470 patients to 16 different comparators. As compared with placebo, levosimendan (odds ratio [OR], 0.17, 95%; confidence interval [CI], 0.05-0.60), dobutamine (OR, 0.30; 95% CI, 0.09-0.99), epinephrine (OR, 0.35; 95% CI, 0.13-0.96), vasopressin (OR, 0.37; 95% CI, 0.16-0.89), and norepinephrine plus dobutamine (OR, 0.4; 95% CI, 0.11-0.96) were significantly associated with survival. Norepinephrine improved survival compared with dopamine (OR, 0.81; 95% CI, 0.66-1.00). Rank analysis showed that levosimendan had the highest probability of being the best treatment.
Among several regimens for pharmacological cardiovascular support in septic patients, regimens based on inodilators have the highest probability of improve survival.
强心剂和血管升压药是感染性休克治疗的基石，但寻找最佳药物的工作仍在进行中。我们旨在确定哪种血管活性药物与最佳生存率相关。
检索了PubMed、BioMedCentral、Embase和Cochrane中央注册库。纳入了在感染性患者中进行的随机试验，其中至少有一组被分配使用强心剂/血管升压药。采用频率学派方法进行网络荟萃分析。
纳入的33项研究将3470例患者随机分配至16种不同的对照药物。与安慰剂相比，左西孟旦（比值比[OR]，0.17；95%置信区间[CI]，0.05 - 0.60）、多巴酚丁胺（OR，0.30；95% CI，0.09 - 0.99）、肾上腺素（OR，0.35；95% CI，0.13 - 0.96）、血管加压素（OR，0.37；95% CI，0.16 - 0.89）以及去甲肾上腺素加多巴酚丁胺（OR，0.4；95% CI，0.11 - 0.96）与生存率显著相关。去甲肾上腺素与多巴胺相比可提高生存率（OR，0.81；95% CI，0.66 - 1.00）。排名分析表明左西孟旦成为最佳治疗药物的概率最高。
在感染性患者的几种药物性心血管支持方案中，基于血管扩张剂的方案提高生存率的概率最高。
